The effect of preoperative anxiety level on mean platelet volume and propofol consumption

BACKGROUND

The mean platelet volume (MPV) is an important indicator of platelet function with large platelets showing higher enzymatic and metabolic activity than other platelets. There can be a relationship between increased platelet activity and anxiety and depression. Our primary hypothesis was that patients with high anxiety scores would have higher MPV, and the secondary hypothesis was that propofol induction time and total propofol consumption within the first 30 min of surgery would be higher in patients with higher anxiety scores.

METHODS

The Beck Anxiety Inventory (BAI) was administered to the participating patients 1 day before surgery to evaluate the level of anxiety. Based on the scores from the BAI, 40 patients with an anxiety score of < 8 were assigned to the non-anxious group (Group NA) and 40 patients with an anxiety score of ≥8 were assigned to the anxious group (Group A). At the anesthesia induction the mean time to achieve an entropy value below 60 (T1) was recorded. The total intraoperative propofol consumption within the first 30 min was recorded.

RESULTS

There was a statistically significant difference between the groups in terms of preoperative MPV and demographic data, including age and sex. The mean total propofol consumption at 30 min after induction in the groups was statistically significant. The cut-off value for MPV was calculated as 9.65.

CONCLUSIONS

The preoperative MPV values and propofol consumption at 30 min among patients with high preoperative anxiety scores were high. We suggest that MPV is helpful in the clinical practice in predicting the amount of anesthetic agents required for the 30 mins of anesthesia.

Is the First Postnatal Platelet Mass as an Indicator of Patent Ductus Arteriosus?

BACKGROUND

The aim of this study is to evaluate whether there is an association between the platelet mass and patent ductus arteriosus (PDA) closure in premature newborns.

METHODS

Preterm infants (gestational age ≤33 weeks) with hemodynamically significant PDA (group 1, n = 178) and a control group of preterm infants without PDA (group 2, n = 211) were retrospectively evaluated between August 1, 2013 and July 30, 2015 in the neonatal intensive care unit (NICU). Platelet counts and platelet indices including mean platelet volume (MPV), and platelet mass (platelet count x mean platelet volume) in the first 24 hours of life, demographic findings and morbidities were recorded.

RESULTS

No differences were observed in demographic findings between the study groups in terms of birth weight, gestational age, gender and maternal risk factors. The mean platelet count in the first postnatal hemogram in group 1 and group 2 were 189.43 ± 72.14 (X103 /mm3) and 206.86 ± 70.11(X103/mm3), respectively (P < 0.05). The MPV were similar in both groups (P > 0.05). Platelet mass values were 1443.70 ± 572.40 fL/nL in Group 1 and 1669.49 ± 1200.42 fL/nL in group 2. There was a statistically significant difference in platelet mass values between the two groups (P = 0.011). Multivariable analysis including presence of thrombocytopenia, MPV and platelet mass showed that hemodynamically significant PDA was not independently associated with platelet count <150 000 (OR = 1.001, 95% CI 0.980-1.023; P = 0.921), MPV (OR = 0.967, 95% CI 0.587-1.596; P = 0.897) or platelet mass (OR = 0.999, 95% CI 0.997-1.002; P = 0.681). The optimal cut-off value of platelet mass for patients with PDA was ≤1530.8 fL/nL (area under the curve [AUC]: 0.580), with sensitivity of 58% and specificity of 56.2% (P = 0.008).

CONCLUSION

Our data suggest that platelet count, MPV, and platelet mass do not contribute to closure of PDA in premature newborns.

The Prognostic Value of Inflammatory Markers in Clostridium difficile-associated Diarrhea

BACKGROUND

The incidence of Clostridium difficile-associated diarrhea (CDAD) is increasing and is associated with significant morbidity and mortality. Therefore, there is a need to find new tools to determine the severity of the disease.

OBJECTIVES

To investigate the prognostic values of inflammatory markers such as mean platelet volume (MPV), neutrophil-lymphocyte ratio (NLR), and C-reactive protein (CRP) in patients with CDAD.

METHODS

The study comprised of 100 patients diagnosed with CDAD. The study included an additional control group of 69 patients with diarrhea who were negative for C. difficile toxin. The control group was age- and sex-matched and hospitalized at the same time period. NLR and MPV were obtained from complete blood count results. Serum CRP levels were measured by the latex particle enhanced immunoturbidimetric assay. Blood samples for all inflammatory markers were collected at time of diagnosis and prior to initiating the antibiotic therapy. Demographic, clinical, laboratory, and prognostic data were collected from medical records for a period of 90 days from the initial diagnosis of CDAD.

RESULTS

The mean age of the CDAD group was 68.6 ± 21.5 years compared to 65.6 ± 24.5 in the control group (P = 0.29). Our findings show that patients with CDAD had significantly higher NLR, MPV and serum CRP levels compared to the control group (P < 0.001)). Moreover, significantly higher levels were observed when CDAD was fatal (P < 0.001).

CONCLUSIONS

Elevated NLR, MPV, and serum CRP levels may serve as biomarkers for prediction of recurrence and mortality in patients with CDAD.

Branch retinal vein occlusion associated with platelet activation

Background/aim

The aim of this study is to study subclinical platelet activation by detecting three important platelet activation parameters of mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT) in patients with branch retinal vein occlusion (BRVO) in comparison to those in healthy control subjects.

Materials and methods

This prospective study included 43 patients with BRVO (Group 1) and 40 control subjects (Group 2). The levels of MPV, PDW, and PCT were measured in both of the studied groups.

Results

The mean serum level of MPV value was 7.64 ± 0.64 in Group 1 and 7.39 ± 0.42 in Group 2. Mean serum level of PDW was 15.01 ± 1.56 in Group 1 and 14.43 ± 1.03 in Group 2. Mean serum PCT value was 0.19 ± 0.05 in Group 1 and 0.16 ± 0.04 in Group 2. MPV, PDW, and PCT levels were significantly increased in BRVO patients (P < 0.05).

Conclusion

Subclinical platelet activation reflected by MPV, PDW, and PCT may have an impact on the genesis of vessel occlusion in BRVO. The results may be important for the clinical management of patients with BRVO.

Prognostic importance of paraoxonase, arylesterase and mean platelet volume efficiency in acute ischaemic stroke

OBJECTIVE

To study the prognostic importance activity of paraoxonase and arylesterase, and the value of mean platelet volume in patients with acute ischaemic stroke.

METHODS

This case-control study was conducted at Harran University Hospital, Sanliurfa, Turkey, from January to June 2014, and comprised patients with symptoms of acute ischaemic stroke who presented to the emergency department. Paraoxonase activity, expressed in units per litre, or U/L, of serum, was evaluated in the absence of basal activity, and arylesterase activity was defined as micromoles, of phenol generated/min, and was expressed as U/L of serum. Mean platelet volume was measured as a routine parameter. SPSS 20 was used for data analysis.

RESULTS

Of the 94 participants, 48(51%) were patients with acute ischaemic stroke and 46(49%) were control subjects. Moreover, 27(56.3%) patients were females and 21(43.7%) were males. In the control group, 26(56.5%) were females and 20(43.5%) were males. The mean age of patients was 68.39±11.83 years compared to controls' 65±9.95 years. Decreased activity of prognostic importance and arylesterase were significant in patients than in the controls (p= 0.016 and p= 0.001, respectively). The median platelets of patients was significantly lower than that of the controls (p=0.004). However, the median mean platelet volume values were similar in the both groups (p=0.568). Binary logistic regression analyses showed that the paraoxonase and arylesterase were risk markers for the patients.

CONCLUSIONS

Decreased paraoxonase and arylesterase activity and decreased platelet counts were observed probably due to increased oxidative stress in acute ischaemic stroke patients.

The mean platelet volume and neutrophil to lymphocyte ratio in obese and lean patients with polycystic ovary syndrome

PURPOSE

Mean platelet volume (MPV) and neutrophil to lymphocyte ratio (NLR) are the new markers of the detection of inflammation. Our aim is to investigate MPV and NLR in lean and obese patients with polycystic ovary syndrome (PCOS).

METHODS

This study was designed to investigate MPV, NLR, and high-sensitive C-reactive protein (hsCRP) levels in 25 obese patients with PCOS and 16 lean patients with PCOS, and our study group was matched with 16 obese and 14 non-obese controls, respectively.

RESULTS

PCOS group had higher MPV, NLR, neutrophil count, neutrophil to total leucocyte ratio, basophil count, waist circumference (WC), insulin, glucose, and HOMA-IR rates than those of controls. hsCRP levels were similar in both groups. Subgroup analyses revealed that obese PCOS group had higher insulin and HOMA-IR levels, compared to those of controls. In this subgroup, total leucocyte counts, MPV, and hsCRP levels were similar. On the other hand, lean PCOS group had higher WC, NLR, MPV, and basophil count than controls. In correlation analysis, hsCRP was positively correlated with body mass index (BMI), WC, total leucocyte count, neutrophil count, while negatively correlated with lymphocyte ratio. Although leucocyte count was positively correlated with BMI, MPV was negatively correlated with BMI, total leucocyte, platelet, and neutrophil counts. NLR was positively correlated with HOMA-IR, hsCRP, BMI, WC, and insulin.

CONCLUSION

Our study demonstrated that MPV and NLR levels are increased despite similar hsCRP levels in patients with PCOS. However, we failed to demonstrate these differences in obese PCOS patients. Further studies with larger sample size are required to determine the significance of BMI in the inflammation of PCOS patients.